II. Definitions
- Constipation
- Derived from latin constipare (to crowd together)
- Difficult stool passage
- Sensation of incomplete evacuation
- Straining at stool
- Decreased stool frequency
- Normal frequency difficult to define
- In U.S., 95% of people pass >3 stools per week
- Therefore, 3 or less stools per week is defined as Constipation
III. Physiology
- See Defecation
IV. Causes
- See Constipation Causes
- See Functional Constipation (most common cause)
- See Medication Causes of Constipation
V. History: General
-
Stool History
- Consider Bristol Stool Scale to identify stool abnormalities
- Stool caliber
- Stool frequency
- Stool consistency
- Duration of Constipation
- Organic causes present as Acute Constipation
- Functional causes present as Chronic Constipation
- Age may direct causes
- Consider Hirschsprung's Disease in younger patients
- Consider Colorectal Cancer in older patients
- Medication History
- See Medication Causes of Constipation
- Laxative Abuse (Phenolphthalein, senna, castor)
- Family History
- Habits
- Dietary Fiber intake
- Clear fluid intake per day
- Caffeine intake
- Physical Exercise
- Ignoring urge to defecate
- Abdominal surgery history
- Risk of intra-abdominal adhesions
VI. History: Red flags suggestive of Organic Constipation (requires Colonoscopy)
- See Organic Constipation
- Age over 50 years old and no prior Colorectal Cancer Screening
- Acute or recent onset Constipation
- Weight loss (especially more than 10 pounds or 4.5 kg)
- Abdominal Pain or cramping
- Rectal Bleeding, Melena, heme-positive stool (Iron Deficiency Anemia)
- Nausea or Vomiting
- Rectal Pain
- Fever
- Change in stool caliber (narrowing)
VII. Exam
-
General Physical Exam
- Signs of Hypothyroidism (skin dry, edema, pallor)
- Neurologic Exam
- Abdominal Exam
- Abdominal Mass
- Bowel sounds (high-pitched or absent)
- Perianal changes
- Hemorrhoids
- Anal Fissures
- Anal stenosis or stricture
-
Digital Rectal Exam!
- Fecal Occult Blood Testing
- Rectal Mass
- Amount and consistency of stool in Rectum
- Stool leakage on Rectal Exam
- Suggests Fecal Impaction or Rectal Prolapse
- Severe pain on Digital Rectal Exam
- Suggests Anal Fissure or Hemorrhoids
- Anal sphincter tone
- Poor sphincter tone suggests neurologic deficit
- Anal Wink loss suggests sacral nerve deficit
VIII. Evaluation
- See Constipation Causes
- See Medication Causes of Constipation
- See Organic Constipation (Acute Constipation)
- See Functional Constipation (most common cause)
IX. Management
- No red flag symptoms or signs
- See Functional Constipation (Chronic Constipation)
- Treat empirically
- If no improvement consider Organic Constipation
- Red Flag symptoms or signs above suggest organic cause
X. References
- Cheskin in Barker (1995) Ambulatory Medicine, p.476-81
- Sartor in Dornbrand (1992) Ambulatory Care, p. 221-5
- Arce (2002) Am Fam Physician 65(11):2283-90 [PubMed]
- Borum (2001) Prim Care 28(3):577-90 [PubMed]
- Wald (2000) Med Clin North Am 84(5):1231-46 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Definition (CCC) | Impression of infrequent or difficult passage of hard, dry feces without cause |
| Definition (CCC) | Difficult passage of hard, dry, feces |
| Definition (MEDLINEPLUS) |
Constipation means that a person has three or fewer bowel movements in a week. The stool can be hard and dry. Sometimes it is painful to pass. At one time or another, almost everyone gets constipated. In most cases, it lasts a short time and is not serious. There are many things you can do to prevent constipation. They include
It's not important that you have a bowel movement every day. If your bowel habits change, however, check with your doctor. NIH: National Institute of Diabetes and Digestive and Kidney Diseases |
| Definition (NCI) | Irregular and infrequent or difficult evacuation of the bowels. |
| Definition (NCI_CTCAE) | A disorder characterized by irregular and infrequent or difficult evacuation of the bowels. |
| Definition (NCI_NCI-GLOSS) | A condition in which stool becomes hard, dry, and difficult to pass, and bowel movements don't happen very often. Other symptoms may include painful bowel movements, and feeling bloated, uncomfortable, and sluggish. |
| Definition (NAN) | Self-diagnosis of constipation and abuse of laxatives, enemas, and suppositories to ensure a daily bowel movement |
| Definition (NAN) | Decrease in normal frequency of defecation accompanied by difficult or incomplete passage of stool and/or passage of excessively hard, dry stool |
| Definition (CSP) | condition in which bowel movements are infrequent or incomplete. |
| Definition (MSH) | Infrequent or difficult evacuation of FECES. These symptoms are associated with a variety of causes, including low DIETARY FIBER intake, emotional or nervous disturbances, systemic and structural disorders, drug-induced aggravation, and infections. |
| Concepts | Sign or Symptom (T184) |
| MSH | D003248 |
| ICD9 | 564.00, 564.0 |
| ICD10 | K59.0 , K59.00 |
| SnomedCT | 162080004, 363693003, 162083002, 197123003, 139356000, 139359007, 139358004, 162082007, 14760008, 129585003 |
| LNC | MTHU013416, MTHU013456, MTHU020768 |
| French | CONSTIPATION, Constipation |
| Portuguese | Constipação Intestinal, OBSTIPACAO, Obstipação, Prisão de Ventre |
| Swedish | Förstoppning |
| Japanese | ﾍﾞﾝﾋﾟ, 便秘症, 便秘 |
| Czech | obstipace, zácpa, Zácpa |
| Spanish | constipación subjetiva, constipación, SAI (trastorno), ESTRENIMIENTO, constipación, SAI, estreñimiento, SAI (hallazgo), estreñimiento, SAI, estreñimiento, SAI (trastorno), dificultad para evacuar el intestino, constipación (hallazgo), constipación, SAI (hallazgo), Constipation NOS, Constipación de Vientre, constipación, estreñimiento (trastorno), estreñimiento subjetivo (trastorno), estreñimiento subjetivo, estreñimiento, Estreñimiento |
| Finnish | Ummetus |
| Russian | ZAPORY, ЗАПОРЫ |
| English | constipation (diagnosis), constipation, constipation (symptom), Constipation NOS, Constipation, unspecified, Constipation [Disease/Finding], rndx unspecified constipation (diagnosis), rndx perceived constipation, rndx unspecified constipation, rndx perceived constipation (diagnosis), constipating, constipated, constipate, difficulty defecating, Constipation symptom, Constipation (& symptom), Constipation (& symptom) (finding), Constipation NOS (finding), Constipation (finding), Costive symptom, Constipation NOS (disorder), Unspecified constipation, CONSTIPATION, Perceived Constipation, Unspecified Constipation, Perceived constipation, Constipation (disorder), Costiveness, Perceived constipation (disorder), Difficult passing motion, Difficulty defaecating, Difficulty defecating, Difficulty opening bowels, Difficulty passing stool, CN - Constipation, Constipated, PERCEIVED CONSTIPATION, fecal; retention, retention; fecal, Constipation |
| German | VERSTOPFUNG, Obstipation, Verstopfung |
| Korean | 변비 |
| Italian | Costipazione, Stipsi |
| Croatian | KONSTIPACIJA |
| Polish | Zaparcie |
| Hungarian | Obstipatio |
| Norwegian | Forstoppelse, Treg mage, Hard avføring, Obstipasjon |
| Dutch | faeces; retentie, retentie; faeces, constipatie, Obstipatie, Constipatie |
